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      Effectiveness of early interventions for parental sensitivity following preterm birth: a systematic review protocol

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          Abstract

          Background

          Parental sensitivity is the interaction process by which parents (a) recognize cues from their infant, (b) interpret these cues adequately, (c) identify an appropriate response and (d) apply this response in an appropriate time frame. In the neonatal intensive care unit, parents of preterm infants often encounter factors hampering the establishment of their parental sensitivity. Parents report the need to be in proximity to and to participate in their preterm infant’s care in order to develop their sensitivity to their newborn infant. To do so, the effectiveness of interventions promoting their parental sensitivity has been evaluated with randomized controlled trials. The purpose of this systematic review is to evaluate the effectiveness of early interventions promoting parental sensitivity of preterm infants’ parents.

          Methods/design

          A search will be done in the following databases: CINAHL, PubMed in addition to Medline, Embase, PsycInfo, Web of Science, Scopus and ProQuest. No restriction for the years of publication will be considered. Two experts will be conducting independently each step of the review. All studies of randomized controlled trials of early interventions, for parents of preterm infants, implemented in the neonatal intensive care unit before the infant has reached 37 weeks of corrected gestational age, will be considered eligible. Primary outcome is parental sensitivity. Depending on the availability and quality of data, a meta-analysis will be done. Alternatively, a qualitative synthesis of data is planned. The systematic review follows the PRISMA recommendations. Finally, risk of bias and quality of the evidence of included studies will be assessed.

          Discussion

          To our knowledge, this will be the first systematic review to examine the effect of early interventions that promote parental sensitivity of parents of preterm infants in the neonatal intensive care unit. The results of this review will guide development of best practice guidelines and recommendations for further research and will have implications for neonatal clinical practice.

          Systematic review registration

          PROSPERO CRD42016047083

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13643-017-0459-x) contains supplementary material, which is available to authorized users.

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          Most cited references11

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          Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis

          Background Preterm infants are at greater risk for neurodevelopmental disabilities than full term infants. Interventions supporting parents to improve the quality of the infant’s environment should improve developmental outcomes for preterm infants. Many interventions that involve parents do not measure parental change, nor is it clear which intervention components are associated with improved parental outcomes. The aim of this review was to categorize the key components of early intervention programs and determine the direct effects of components on parents, as well as their preterm infants. Methods MEDLINE, EMBASE, CINAHL, ERIC, and Cochrane Database of Systematic Reviews were searched between 1990 and December 2011. Eligible randomized controlled trials (RCTs) included an early intervention for preterm infants, involved parents, and had a community component. Of 2465 titles and abstracts identified, 254 full text articles were screened, and 18 met inclusion criteria. Eleven of these studies reported maternal outcomes of stress, anxiety, depressive symptoms, self-efficacy, and sensitivity/responsiveness in interactions with the infant. Meta-analyses using a random effects model were conducted with these 11 studies. Results Interventions employed multiple components categorized as (a) psychosocial support, (b) parent education, and/or (c) therapeutic developmental interventions targeting the infant. All interventions used some form of parenting education. The reporting quality of most trials was adequate, and the risk of bias was low based on the Cochrane Collaboration tool. Meta-analyses demonstrated limited effects of interventions on maternal stress (Z = 0.40, p = 0.69) and sensitivity/responsiveness (Z = 1.84, p = 0.07). There were positive pooled effects of interventions on maternal anxiety (Z = 2.54, p = 0.01), depressive symptoms (Z = 4.04, p <.0001), and self-efficacy (Z = 2.05, p = 0.04). Conclusions Positive and clinically meaningful effects of early interventions were seen in some psychosocial aspects of mothers of preterm infants. This review was limited by the heterogeneity of outcome measures and inadequate reporting of statistics. Implications of key findings Interventions for preterm infants and their mothers should consider including psychosocial support for mothers. If the intervention involves mothers, outcomes for both mothers and preterm infants should be measured to better understand the mechanisms for change.
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            Parenting in the neonatal intensive care unit.

            A systematic review of the literature was conducted to answer the following 2 questions: (a) What are the needs of parents who have infants in the neonatal intensive care unit? (b) What behaviors support parents with an infant in the neonatal intensive care unit? Using the search terms "parents or parenting" and the "neonatal intensive care unit," computer library databases including Medline and CINAHL were searched for qualitative and quantitative studies. Only research published in English between 1998 and 2008 was included in the review. Based on the inclusion criteria, 60 studies were selected. Study contents were analyzed with the 2 research questions in mind. Existing research was organized into 1 of 3 tables based on the question answered. Nineteen articles addressed the first question, 24 addressed the second, and 17 addressed both. Six needs were identified for parents who had an infant in the neonatal intensive care unit: (a) accurate information and inclusion in the infant's care, (b) vigilant watching-over and protecting the infant, (c) contact with the infant, (d) being positively perceived by the nursery staff, (e) individualized care, and (f) a therapeutic relationship with the nursing staff. Four nursing behaviors were identified to assist parents in meeting these needs: (a) emotional support, (b) parent empowerment, (c) a welcoming environment with supportive unit policies, and (d) parent education with an opportunity to practice new skills through guided participation.
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              Early interventions involving parents to improve neurodevelopmental outcomes of premature infants: a meta-analysis.

              To determine in a systematic review, whether interventions for infant development that involve parents, improve neurodevelopment at 12 months corrected age or older. Randomized trials were identified where an infant intervention was aimed to improve development and involved parents of preterms; and long-term neurodevelopment using standardized tests at 12 months (or longer) was reported. Identified studies (n=25) used a variety of interventions including parent education, infant stimulation, home visits or individualized developmental care. Meta-analysis at 12 months (N=2198 infants) found significantly higher mental (N=2198) and physical (N=1319) performance scores favoring the intervention group. At 24 months, the mental (N=1490) performance scores were improved, but physical (N=1025) performance scores were not statistically significant. The improvement in neurodevelopmental outcome was not sustained at 36 months (N=961) and 5 years (N=1017). Positive clinically meaningful effects (>5 points) are seen to an age of 36 months, but are no longer present at 5 years.
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                Author and article information

                Contributors
                andreane.lavallee@umontreal.ca
                marilyn.aita@umontreal.ca
                anne.bourbonnais@umontreal.ca
                gwenaelle.de.clifford@umontreal.ca
                Journal
                Syst Rev
                Syst Rev
                Systematic Reviews
                BioMed Central (London )
                2046-4053
                23 March 2017
                23 March 2017
                2017
                : 6
                : 62
                Affiliations
                [1 ]ISNI 0000 0001 2292 3357, GRID grid.14848.31, Faculty of Nursing, , Université de Montréal, ; 2375 Chemin de la Côte-Sainte-Catherine, Montreal, Qc H3T 1A8 Canada
                [2 ]ISNI 0000 0000 9064 4811, GRID grid.63984.30, , Research Center of the CHU Sainte-Justine, ; Montreal, Canada
                [3 ]GRID grid.294071.9, , Research Center of the Institut universitaire de gériatrie de Montréal, ; Montreal, Canada
                Author information
                http://orcid.org/0000-0001-5702-3084
                Article
                459
                10.1186/s13643-017-0459-x
                5364600
                f495a8ca-544e-40dc-ab56-f131263d4de5
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 2 December 2016
                : 15 March 2017
                Funding
                Funded by: TD Bank
                Categories
                Protocol
                Custom metadata
                © The Author(s) 2017

                Public health
                infant,premature,parenting,parent-child relations,parental sensitivity,interventions,systematic review,trials

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